Finding Medicare Plans in Washington
The good news is that there are Medicare options for Washingtonians to choose from. But, sorting through all of the options to find the right coverage can be overwhelming. We don’t think it has to be! We’ve created this guide to help navigate you through the Medicare plans in Washington so that you find the coverage you need.
When Am I Eligible for Medicare Plans in Washington?
Medicare is a federal health insurance program available to American citizens and permanent residents who qualify, by either age or disability.
If you’re 65 or older, you may qualify for Medicare if:
- You are a citizen or permanent resident (having lived in the US for at least 5 years), and
- You or your spouse worked at a job that paid towards your Medicare through Social Security deductions for at least 10 years.
If you’re under 65, you may qualify for Medicare if you have:
- been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
- received Social Security Disability Insurance (SSDI) for at least 24 months
We can help you determine your eligibility for Medicare plans in Washington or help you prepare for your upcoming eligibility. View plans in your area online or talk to a licensed insurance agent now by calling us.
What Does Medicare Cover?
Medicare is a federal health insurance program for those who qualify by age or disability status. To see what’s covered we’ll look at the four parts of Medicare individually.
Original Medicare (Parts A and B)
Original Medicare is the governmental part of Medicare. It’s split in to two parts:
Part A (Hospital Insurance) covers inpatient services, like hospital care, hospice, skilled nursing facility care, and nursing home care (as long as custodial care isn’t the only care needed).
Part B (Medical Insurance) covers outpatient services and supplies, like mental health, ambulance services, and durable medical equipment (blood sugar monitors, walkers, canes, etc). Part B also covers certain services that prevent or detect illnesses early, like flu shots, cardiovascular and diabetes screenings.
Original Medicare doesn’t cover everything. Services generally not covered by Original Medicare include:
- Long term care (custodial care)
- Most outpatient prescription drugs
- Hearing aids
- Eye exams and eyeglasses
- Most dental care and dentures
- Routine foot care
- Cosmetic surgery
Medicare doesn’t cover everything and isn’t intended to pay 100% of your medical bills. Medicare beneficiaries typically pay a portion of medical expenses in the form of deductibles, coinsurance, and copayments. Washingtonians have additional Medicare options, available through Medicare-approved private insurance companies, to expand their Medicare coverage.
Medicare Advantage Plans (Part C)
Medicare Advantage plans, offered by Medicare-approved private insurance companies, work as an alternative to the coverage provided by Original Medicare (Parts A and B). These plans provide the same coverage as Original Medicare and can also include additional benefits, like dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.
You must be enrolled in both parts of Original Medicare to enroll in a Medicare Advantage plan. Premiums can start at $0 and increase depending on the level of coverage selected. You’ll continue paying your Part B premium in addition to your Part C premium.
Medicare Prescription Drug Plans (Part D)
Prescription drugs are not covered by Original Medicare (Parts A and B) or Medigap plans. Stand-alone Medicare Prescription Drug plans, offered by Medicare-approved private insurance companies, work alongside Original Medicare to limit your out-of-pocket costs for medications. Medications are put into tiers, each tier with a certain copay or coinsurance. Each Medicare Part D plan provides a formulary, so you can see what the coinsurance/copay would be for each drug. This way, you can select the plan that best matches your prescription needs.
Medicare Supplement Plans (Medigap)
As mentioned earlier, Medicare beneficiaries are still responsible for paying a portion of their medical bills. This is where Medicare Supplement plans come in. These plans are available through private insurance companies, approved by Medicare, and work alongside Original Medicare to cover certain costs, like copayments, coinsurance, and deductibles. If you plan to stick with Original Medicare, a Medigap plan can help reduce your out-of-pocket costs.
When Can I Enroll in A Medicare Plan?
Medicare Advantage and Prescription Drug Plans
Your Initial Enrollment Period (IEP) is your first opportunity to enroll in Medicare. This IEP is a seven-month period, starting three months before your 65th birthday month.
You can then make changes to your Medicare Advantage or Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period runs from October 15th to December 7th every year.
Key Fact: The General Enrollment Period offers another chance to enroll in Original Medicare, in case you missed your IEP. This period occurs each year from January 1st to March 31st. If you want to enroll in a Medicare Advantage plan, you can do so from April 1st to June 30th every year.
Medicare Supplement Plans
The best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This six-month period begins at the start of your 65th birthday month, assuming you’ve enrolled in Medicare Part B. Otherwise, your Medigap Open Enrollment Period would start the same month as your Medicare Part B coverage.
Important Note: You are guaranteed the Medigap plan of your choice if you enroll during this period. But if you don’t enroll within this period, you could be charged higher premiums or be denied coverage entirely.
Special Enrollment Periods
Special Enrollment Periods allow you to enroll or make changes to your Medicare coverage outside of the normal times. Special Enrollment Periods are granted to those who’ve experienced special circumstances or a qualifying life event. Qualifying life events include moving addresses, losing insurance coverage, moving into or out of a care facility, and more. Our licensed insurance agents can help determine if you qualify for a Special Enrollment Period.
How Do I Select a Medicare Plan?
We’ll help you sort through the many Medicare plans in Washington.
Give us a call to speak to a licensed insurance agent or compare plans online by using our form below.
Additional Medicare Resources in Washington
The Statewide Health Insurance Benefits Advisors (SHIBA) is part of the insurance commissioner’s consumer protection services. SHIBA provides free, unbiased, and confidential assistance with Medicare and health care choices.
Washington’s Medicare Savings Program is available to Medicare beneficiaries in Washington that have little or no income to help pay for Medical expenses, like premiums and deductibles.
Sources: Medicare.gov; www.insurance.wa.gov; www.dshs.wa.gov